Healthcare Provider Details

I. General information

NPI: 1992111926
Provider Name (Legal Business Name): IGNACIO CALDERON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 E SHAW AVE
FRESNO CA
93710-7919
US

IV. Provider business mailing address

28637 ROCK CANYON DR
SANTA CLARITA CA
91390-5241
US

V. Phone/Fax

Practice location:
  • Phone: 559-881-7425
  • Fax:
Mailing address:
  • Phone: 805-746-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: